Outline

Objective: In this study the aim was to evaluate the feasibility of surgical treatment in patients with gliomas involving the cingulate gyrus as part of the limbic system in a series of 47 cases. These tumors often reach and affect the corpus callosum and the central region making operative treatment complicated.

Methods: We analyzed preoperative data, surgical treatment, functional outcome and survival of 47 patients (f:m; 23/24) with gliomas arising from the cingulate gyrus with a mean age of 45 years (Â±14 y). The data was entered in a prospectively conducted database of gliomas between June 1999 and January 2010. The cingulate gyrus was divided by the central sulcus into an anterior and posterior part. The extent of resection was based on the early postoperative MRI and labeled as complete, subtotal (<5% residual tumor) and partial (>5% residual tumor).

Results: The majority (85%) of the gliomas were located in the anterior part of the cingulate gyrus and 15% in the posterior part. Seizures were the dominant presenting symptom in 25 patients (53%). 7 patients (15%) presented with hemiparesis. The mean preoperative Karnofsky index was 90 (SDÂ±16, range 40–100) and the mean preoperative NIHSS Score was 1 (SDÂ±1.6, range 0–5). Histopathological examination showed a WHO grade II tumor in 9 patients (19%), a WHO grade III tumor in 13 patients (28%) and a glioblastoma in 25 patients (53%). In 26 (55%) patients complete resection, in 16 (34%) patients subtotal resection and in 5 (11%) patients partial resections was achieved. 7 (15%) patients showed a SMA lesion and 4 (11%) patients had new or worsened hemiparesis postoperatively. The early postoperative NIHSS score (2–5 days) was 2 (SDÂ±1.4, range 0–5) and the late postoperative NIHSS score (30 days) was 0 (SDÂ±1.2, range 0–6; p<0.001). Up to today 20/47 patients died (3 grade II, 1 grade III, 16 grade IV). The mean survival time of all patients including the living is 56 (Â±62) month in grade II, 59 (Â±58) month in grade III and 13 (Â±18) month in grade IV.

Conclusions: Microsurgical resection of gliomas arising from the cingulate gyrus is feasible, even complete resection can be achieved in many tumors arising from the cingulate gyrus. Functional outcome of the patients is good, even though some patients experience transient deficits